Sleep apnea was always a problem; we just didn’t have the resources readily available for testing and diagnosis. Now, there are sleep labs or accredited sleep centers to run tests for evaluation. This increase in diagnostic capabilities has lead to better, more accurate diagnosis of obstructive sleep apnea (OSA).
Snoring is caused primarily by vibration of the tissues of the oropharynx and the soft palate. Snoring may be benign (other than disturbing the sleep of the bed partner). It may fragment the person’s sleep. Or it may be a sign of obstructive sleep apnea, which can be life-threatening.
Obstructive sleep apnea occurs when the tissues of the oropharynx collapse during sleep and block the airway. A complete blockage for 10 seconds or more is referred to as an apnea. A reduction of airflow by 30-50% is referred to as a hypopnea. The level of a person’s obstructive sleep apnea is measured by how many apneas and how many hypopneas occur per hour. This is referred to as the apnea-hypopnea index (AHI).
The treatment of obstructive sleep apnea is continuous positive airway pressure (CPAP). CPAP consists of a mask that goes over your nose and mouth with a hose attached to a machine that delivers positive air pressure during your sleep. Unfortunately, about 10% of patients who are diagnosed with OSA are not willing to try CPAP. Of those who do try CPAP, between 20 and 40% give up within the first year. The reasons for giving up on CPAP include difficulty finding a mask that fits well, mask leak, air leaking through the mouth, skin reaction to the mask, problems with the straps that hold on the mask, bed partner complaints due to the noise of the system, claustrophobia, dry nose or mouth, sinus problems, and even dental problems.
For those who do not, or are unable to use CPAP, we can help. According to guidelines published by the American Academy of Sleep Medicine, oral appliance therapy is indicated as a first-line therapy in mild to moderate sleep apnea and is also indicated in severe sleep apnea when a patient has failed CPAP. Surgery is generally not indicated with OSA and palatal surgeries are rarely successful.
The principles behind oral appliance therapy are simple. The patient’s airway is blocked due to the tongue falling into the throat while the patient is sleeping. The oral appliance keeps the lower jaw forward during sleep. There are appliances that we can employ to achieve the desired result—which is reduction of the apneas and hypopneas to less than 10 events per hour.
There is NO WAY to tell with certainty by looking at someone if they are just a snorer or if they have severe sleep apnea. Accurate diagnosis is the key, and this is best performed by a medical doctor.
As a Dentist, we can help you by screening and seeing signs of sleep disorder such that you may benefit by referral to a sleep center for evaluation by a medical doctor. Should you have concerns, please feel free to give us a call.